Physician Assistants Experience Liberia

Duquesne Students in Africa Treat Patients, Bring Home Faith-filled Lessons

In the African country of Liberia, malaria, yellow fever, typhoid and worms replace Western concerns of heart attacks, high blood pressure and high cholesterol. Only 51 percent of all births are attended by skilled health care providers.

The lone blood pressure cuff in a hospital might be unreliable. The supposedly sterile surgical suite might have a crowing chicken - the surgical technician's supper for that night - inside a cupboard.

As part of their clinical rotations, five Duquesne University physician assistant students and a faculty adviser recently spent two weeks working in Liberia. These fifth-year graduate students served in the maternity ward of ELWA Hospital in the Liberian capital of Monrovia, providing pre- and post-natal care, as well as emergency care, surgical services and inpatient services for adults and children.

In addition, they volunteered in an ambulatory clinic in the jungle, a walk-in clinic in the bush and treated minor illnesses at orphanages. Generally, they provided care, supplies and compassion.

A New View on Accessibility

"We went from Pittsburgh, one of the best places in the world for health care, to one of the poorest countries," says Mark Freeman, the trip's faculty mentor and assistant professor in Duquesne's physician assistant program. "We saw illnesses we had just read about-malaria, typhoid and other diseases that we think are under control. It has given us a lesson in resourcefulness, hope and faith, and provided life-changing experiences that give us a new perspective on our own health care in the U.S."

Despite debate about American health care reform, student Kayla Breindel observes, "We're so lucky for the health care we have; we have the opportunity to get health care." That is far from the case in Liberia,students discovered.

"There is such a lack of supplies, room, organization and staff motivation-which is no wonder, seeing the conditions they are dealing with," says student Laura Berkebile. "The hospital probably has about 100 beds and three doctors." An inpatient stay can cost as much as $5 to $10 U.S. - the equivalent of a year's salary for many Liberians.

As a result, Freeman explains, "They wait to seek health care until the last minute. If they could receive preventive health care, you could do so much more for them. It's amazing to see people march across the field in the morning to go to the hospital - and know that not many of them are going to walk back because of the diseases they have."

Struggling to Share Compassion

Breindel and classmate Olivia Hess tell of a 20-year-old man whose brother brought him to the hospital. The hospital's single X-ray machine was down, there was no ultrasound equipment, the pulse oximeter didn't work and the blood pressure cuff was unreliable, but their best guess was the young man had a small bowel obstruction compounded by malaria. "Both would have been easily treated in the U.S.," says Hess. In Liberia, his situation was grim.

"He was looking up at Kayla and me, and we held his hand the entire day," says Hess. The doctors, who had dismissed his case as futile as soon as they saw him, were all gone when he gasped his last breath. Hess administered CPR, to no avail. "To Liberian people, death is a common occurrence," says Freeman.

Compassion is in short supply in a land desensitized to death as a result of civil wars and deadly medical conditions. In a remote village, after a long dirt road ride from Monrovia, the Duquesne group encountered hundreds-including many children - who sought medical treatment. "A lot of the kids there have worms-hookworms, tapeworms, other worms - and we had prepackaged medicine for 70 of them," remembers student Michael Lynn. "It was tough. You have to draw a line. It gives you an awareness of the lack of resources and supplies there."

A Life-Changing Experience

Altogether, the students treated nearly 250 villagers in the bush, many of whom walked for hours to be evaluated. "The entire experience in Liberia was life-changing, spiritually, emotionally and clinically," says student Amanda Candelmo, who delivered a baby boy by herself.

"The women in Liberia experience all childbirth naturally and are not given the option of medication for pain relief," she says. "These women continuously pray to God for strength and guidance during delivery and do not complain of the pain they are bearing. This was such a powerful testament to faith for me, and it was so beautiful to experience."